Few interesting cases were seen in today's ward-round
1. A 60-year old lady who's previously well with only known hypertension was admitted with 1 month's history of progressive bilateral glove-stocking distribution of sensory loss, tingling pain, and proximal / distal muscle weakness. Examination showed wasting of small hand & feet muscles, power 3 in all 4 limbs, generalised hyporeflexia & hypotonia in all 4 limbs, CN VII / XII palsy, and mild bilateral ptosis. Otherwise, ECG, cardiovascular, GI, and urological symptoms were unable. Patient is currently investigated for nerve conduction abnormalities, and herself & family are uncertain about this thus deferred. Possible diagnosis include CIDP v.s. other causes of peripheral sensory-motor polyneuropathy
Reading:
- CIDP on emedicine
2. Found out from renal that statin-induced myopathy is more common in nephrotic syndrome. A young man in his mid-thirities was admitted for headache which turned out to be a cerebral sinus thrombosis. His cholesterol was noted to be very high thus recommended to increase his simvastatin to atorvastatin 80mg. Baseline LFT was normal, however his renal team came by and recommended his dose to be reduced because of increased rhabdomyolysis risk
- Further raeding on FDA
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